Reporte de cuatro casos clínicos de bacteriemia por Hafnia alvei en una unidad cardio-quirúrgica pediátrica / Report of four clinical cases of Hafnia alvei bacteremia in a pediatric cardiac surgery unit

Introduction: The gram-negative bacillus Hafnia alvei is the only species of the genus Hafnia, family Enterobacteriaceae. It occasionally behaves as an opportunistic pathogen in humans, causing intestinal and respiratory infection and sepsis. It rarely causes bacteremia, usually of unknown focus. Objective: To describe a nosocomial outbreak of four pediatric patients with bacteremia by Hafnia alvei. Methods: Descriptive study using clinical records of pediatric patients diagnosed with Hafnia alvei bacteremia in a pediatric cardio surgical unit, in October 2008. Results: The attack rate was 4/8 (50 percent), lethality rate 2/4 (50 percent) and mortality 2/8 (25 percent). The microbiological study and pulsed-field gel electrophoresis confirmed the same clonal bacterial strain. Discussion: The source of bacteremia was identified only in two patients and was associated with central venous catheters. The other two cases had no known infectious source. Epidemiological surveillance of emerging agents must be maintained.

Introducción: Hajhia alvei, bacilo Gram negativo, constituye la única especie del género Hajhia, familia Enterobacteriaceae. En el humano se comporta ocasionalmente como oportunista produciendo infección intestinal, respiratoria y sepsis. Es causa infrecuente de bacteriemias, generalmente de foco infeccioso desconocido. Objetivo: Describir un brote intrahospitalario de cuatro pacientes pediátricos con bacteriemias por Hajhia alvei. Método: Estudio descriptivo retrospectivo de los registros clínicos de cuatro pacientes pediátricos con diagnóstico de bacte-riemia por Hajhia alvei en una unidad cardioquirúrgica pediátrica identificados en octubre del 2008. Resultados: La tasa de ataque fue 4/8 (50 por ciento), tasa de letalidad 2/4 (50 por ciento) y de mortalidad de 2/8 (25 por ciento). El estudio micro-biológico y la electroforesis de campo pulsado confirman la misma cepa bacteriana clonal. Discusión: Se identificó el origen de la bacteriemia sólo en dos pacientes asociado a catéter venoso central. Los otros dos casos no tuvieron foco infeccioso conocido. Se debe mantener vigilancia epidemiológica de agentes emergentes.

[Molecular subtyping of Salmonella enterica serotype Enteritidis in a post epidemic period]. / Subtipificación molecular de Salmonella entérica serotipo Enteritidis en el período post epidémico.

BACKGROUND: In the last two decades, Salmonella enterica serotype Enteritidis has become one of the main agents causing food borne diseases worldwide. This agent is transmitted mainly by contaminated meat and poultry. AIM: To determine the genetic subtypes of Salmonella enterica serotype Enteritidis, circulating in Chile between 2001 and 2003, a post epidemic period. MATERIAL AND METHODS: One hundred ninety three isolates coming from human samples, prepared foods and animal products for human consumption, were analyzed by pulsed field electrophoresis, using PulseNet standardized protocol. RESULTS: Thirteen subtypes of Salmonella enterica serotype Enteritidis were identified, that had between 0 and 13 bands. A predominant subtype was identified in 172 strains (88%) that came from human isolates, prepared foods and animal products for human consumption. Other four subtypes, found in prepared foods and animal products for human consumption, were also found in human isolates. Most subtypes were tightly interrelated Subtypes II, VIII and XI were also found in the 1994 epidemic. CONCLUSIONS: Subtyping of bacterial strains by pulsed field electrophoresis is useful for the surveillance of food borne diseases.

[Genetic markers in four Chilean families with familial Creutzfeldt-Jakob disease]. / Forma familiar de la enfermedad de Creutzfeldt-Jakob: marcadores genéticos en 4 familias chilenas.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a form of transmissible spongiform encephalopathy, in which a prion protein (PrP Sc) accumulates in the brain of affected individuals. Chile has a prevalence of CJD that is more than twice than in the rest of the world and has the highest rate of familial forms. These later forms are associated with the heterozygocity of codon 200 of PrP protein gene. AIM: To search susceptibility genetic markers of CJD in members of families affected by CJD. MATERIAL AND METHODS: A blood sample was obtained from 50 individuals pertaining to four families affected by CJD. DNA from peripheral mononuclear cells was amplified by polymerase chain reaction and sequenced for the gene that codifies PrP protein. RESULTS: In family A, 21 of 23 members were homozygotes for codon 129 (Met/Met) and eight were simultaneously heterozygotes for codon 200 (Glu/Lys). In family B, six of nine members were homozygotes for codon 129, five were heterozygotes for codon 200 and four had both mutations. In family C, the four analyzed subjects were homozygotes for codon 129 and two were simultaneously heterozygotes for codon 200. In family D, nine of 14 members were homozygotes for codon 129 and two were simultaneously homozygotes for codon 200. No family had polymorphisms for codon 219. CONCLUSIONS: Thirty two percent of analyzed subjects were homozygotes for codon 129 and heterozygotes for codon 200, condition that defines the genetic susceptibility to acquire CJD. The dominant tendency of these genotypes could explain the higher incidence of CJF in Chile.

[Leuconostoc infections in patients with short gut syndrome, parenteral nutrition and continuous enteral feeding]. / Infección por Leuconostoc en pacientes con síndrome de intestino corto, nutrición parenteral y alimentación enteral continua.

Leuconostoc is a gram-positive cocci, quite ubiquitous in nature. It is used in wine industry, and for aroma and texture of dairy products. Occasionally it has been isolated from humans in cases of bacteremia, catheter associated infections, sepsis, meningitis, pneumonia, UTI, osteomyelitis and hepatic dysfunction. Short bowel syndrome, patients with CVC and patients with gastrostomy undergoing enteral feeding, are described amongst the factors associated with this infection. The isolation of a gram-positive cocci, that does not hydrolyze arginine and that is resistant to vancomycin leads to this diagnostic possibility. Antibiotic treatment: penicillin or ampicillin.

Infección por Leuconostoc en pacientes con síndrome de intestino corto, nutrición parenteral y alimentación enteral continua / Leuconostoc infcctions in patients with short gut syndrome, parenteral nutrition and continuous enteral feeding

Leuconostoc is a grampositive cocci, quite ubiquitous in nature. It is used in wine industry, and for aroma and texture of dairy products. Occasionally it has been isolated from humans in cases of bacteremia, catheter associated infections, sepsis, meningitis, pneumonia, UTI, osteomyelitis and hepatic dysfunction. Short bowel syndrome, patients with CVC and patients with gastrostomy undergoing enteral feeding, are described amongst the factors associated with this infection. The isolation of a grampositive cocci, that does not hydrolyze arginine and that is resistant to vancomycin leads to this diagnostic possibility. Antibiotic treatment: penicillin or ampicillin.

Leuconostoc es una cocácea grampositiva parecida a los Streptococcus, que se encuentra ampliamente distribuida en la naturaleza; es usada en la industria de vinos, productos lácteos y quesos para la producción de aromas y texturas. Leuconostoc causa ocasionalmente infecciones en humanos, puede producir bacteriemia, infección asociada a catéter, síndrome séptico, meningitis, neumonía, infección del tracto urinario, osteomielitis y compromiso hepático, entre otros. Se describen como factores de riesgo para una infección por este agente: el síndrome de intestino corto, uso de catéter venoso central y la alimentación enteral por gastrostomía. Orientan a la presencia de este agente el aislamiento de una cocácea grampositiva, catalasa negativa, PYR y LAP negativas, resistente a vancomicina. El tratamiento de elección es penicilina o ampicilina.

[Rapid identification of non tuberculous mycobacteria by restriction pattern analysis]. / Identificación rápida de micobacterias no tuberculosas mediante análisis de patrones de restricción.

BACKGROUND: The frequency of diseases caused by non tuberculous mycobacteria has increased in the last years. Their clinical diagnosis is difficult, mainly in immunocompromised patients. The identification of these mycobacteria by traditional methods is based on phenotypic characteristics and the results are obtained two to four weeks after their isolation in primary cultures. AIM: To report a new identification method for non tuberculous mycobacteria. MATERIAL AND METHODS: The restriction pattern analysis method was implemented. It is based on the amplification, using polymerase chain reaction (PCR), of a polymorphic region of 440 base pairs that codifies Hsp65 protein, followed by a digestion with BstE II and Hae III restriction enzymes. The results were compared with patterns established for each strain. RESULTS: Sixty four strains of mycobacteria obtained from clinical samples and seven reference mycobacteria, were identified using the traditional methods and restriction pattern analysis. The latter method identified the same strain as the former in 87.5% of cases. In the remainder 12.5% of cases there was no agreement between both methods. In these, the sequencing of a fragment of a gene that codifies 16S ribosomal RNA, confirmed the correct identification by restriction patterns. CONCLUSIONS: Restriction pattern analysis is a rapid identification method for non tuberculous mycobacterial strains.

Forma familiar de la enfermedad de Creutzfeldt-Jakob: marcadores genéticos en 4 familias chilenas / Genetic markers in four Chilean families with familial Creutzfeldt-Jakob disease

Background: Creutzfeldt-Jakob disease (CJD) is a form of transmissible spongiform encephalopathy, in which a prion protein (PrP Sc) accumulates in the brain of affected individuals. Chile has a prevalence of CJD that is more than twice than in the rest of the world and has the highest rate of familial forms. These later forms are associated with the heterozygocity of codon 200 of PrP protein gene. Aim: To search susceptibility genetic markers of CJD in members of families affected by CJD. Material and methods: A blood sample was obtained from 50 individuals pertaining to four families affected by CJD. DNA from peripheral mononuclear cells was amplified by polymerase chain reaction and sequenced for the gene that codifies PrP protein. Results: In family A, 21 of 23 members were homozygotes for codon 129 (Met/Met) and eight were simultaneously heterozygotes for codon 200 (Glu/Lys). In family B, six of nine members were homozygotes for codon 129, five were heterozygotes for codon 200 and four had both mutations. In family C, the four analyzed subjects were homozygotes for codon 129 and two were simultaneously heterozygotes for codon 200. In family D, nine of 14 members were homozygotes for codon 129 and two were simultaneously homozygotes for codon 200. No family had polymorphisms for codon 219. Conclusions: Thirty two percent of analyzed subjects were homozygotes for codon 129 and heterozygotes for codon 200, condition that defines the genetic susceptibility to acquire CJD. The dominant tendency of these genotypes could explain the higher incidence of CJF in Chile.

Identificación rápida de micobacterias no tuberculosas mediante análisis de patrones de restricción / Rapid identification of non tuberculous mycobacteria by restriction pattern analysis

Background: The frequency of diseases caused by non tuberculous mycobacteria has increased in the last years. Their clinical diagnosis is difficult, mainly in immunocompromised patients. The identification of these mycobacteria by traditional methods is based on phenotypic characteristics and the results are obtained two to four weeks after their isolation in primary cultures. Aim: To report a new identification method for non tuberculous mycobacteria. Material and methods: The restriction pattern analysis method was implemented. It is based on the amplification, using polymerase chain reaction (PCR), of a polymorphic region of 440 base pairs that codifies Hsp65 protein, followed by a digestion with BstE II and Hae III restriction enzymes. The results were compared with patterns established for each strain. Results: Sixty four strains of mycobacteria obtained from clinical samples and seven reference mycobacteria, were identified using the traditional methods and restriction pattern analysis. The latter method identified the same strain as the former in 87.5% of cases. In the remainder 12.5% of cases there was no agreement between both methods. In these, the sequencing of a fragment of a gene that codifies 16S ribosomal RNA, confirmed the correct identification by restriction patterns. Conclusions: Restriction pattern analysis is a rapid identification method for non tuberculous mycobaterial strains.

Epidemiología molecular de un brote de infecciones por streptococucus pyogenes en una unidad de quemados / Molecular epidemiology of a streptococcus pyogenes related nosocomial outbreak in a burn unit

Group A Streptococcal (GAS) infections have increased in frequency and severity worldwide. During April 1996, a nosocomial outbreak associated to GAS infections affected seven patients admitted to a pediatric burn unit. The causative organism was likely disseminated from the source patient to another child in the emergency room before he was transferred to the burn unit. Patients developed burn infections or invasive disease. One of them died due to a toxic shock syndrome and 3 other lost their skin grafts. Perineal and nasal microbiological surveillance of 42 related health care workers identified only one of them as carrier of S pyogenes. Aim: To report a molecular analysis of an apparently clonal outbreak. Material and methods: The available isolates were analyzed by molecular methods including random amplified polymorphic DNA analysis (RAPD) with 4 different primers, Sma-I pulsed field gel electrophoresis (PFGE) analysis, and speA, speB and speC detection by polymerase chain reaction (PCR). Results: Two phylogenetically distant and sequentially isolated bacterial groups were identified either by RAPD analysis with selected primers or by Smal-PFGE analysis. The first group involved isolates identified in two patients that included the lethal case. The second bacterial group comprised 5 clinical isolates and the perineal and nasal isolates obtained from a health care worker. Only strains belonging to the first group harbored the speA gene and were associated with invasive disease. The second group could be split further in two subgroups according to their speB profile. Conclusions: RAPD analysis with selected primers can reproduce the PFGE-discriminating ability on the epidemiological analysis of GAS infections

Serratia marcescens: Descripción de un brote de infección intrahospitalaria / Serrtia marcesceens: description of a nosocomial outbreake

We describe a nosocomial outbreak of Serratia marcescens infections in different departaments, which occurred between May and December 2001. It involved 85 patients, 72 with clinical infections and 13 in which the strains isolated were found as colonization. The most common site was urinary tract infection. Thirty six percent of the infections were severe (including pneumonia and bacteremia), occurring in patients older than 65 years, with predisposing conditions, previous antibiotic usage, prolonged hospitalisation and invasive procedures. Global lethality was 2,8%. All the cases had genetically the same strain, so a common source of infection was thought. The environmental and water microbiological studies yielded no growth of Serratia, except for the water faucet in the Neurology ward, where the index case was detected, and probably where the epidemic originated.

Se describe un brote de infección intrahospitalaria por Serratia marcescens ocurrido entre mayo y diciembre del 2001 en el Hospital Del Salvador, comprometiendo a varios servicios clínicos. Este brote involucró 85 pacientes con 72 infecciones y 13 colonizaciones. La localización más frecuente de las infecciones fue la urinaria. El 36% de las infecciones fue grave (neumonías y bacteremias), afectando a pacientes sobre 65 años de edad, con patologías predisponentes como: hospitalización prolongada, procedimientos invasores, cirugía y uso de antimicrobianos previos. La letalidad global fue de 2,8%. Todos los casos correspondieron genéticamente a la misma cepa por lo que se planteó una probable fuente común de infección. El estudio microbiológico de las muestras ambientales y de las aguas no detectó S. marcescens, a excepción de un grifo del lavamanos del Servicio de Neurología donde se detectó el caso índice, por lo cual se puede deducir que probablemente éste fue el origen del brote epidémico.

Cambios epidemiológicos de las salmonelosis en Chile: desde salmonella typhi a salmonella enteritidis / Changes in epidemiological patterns of salmonellosis in Chile: since salmonella typhi to salmonella enteritidis

Chile ha experimentado un cambio epidemiológico en la última década con la desaparición progresiva de la fiebre tifoidea causada mayoritariamente por Salmonella typhi y la emergencia epidémica de Salmonella enteritidis, un agente de diarrea sin tratamiento específico eficaz y ligado estrechamente a productos avícolas contaminados e inadecuadamente preparados. La fiebre tifoidea ha disminuido su importancia debido al desarrollo humano experimentado en Chile que ha significado un alto grado de cobertura de agua potable y de manejo de excretas, en conjunto con un mayor nivel de educación, factores que limitan la contaminación del ambiente por este agente y la adquisición de él por huéspedes susceptibles. A pesar de este notable avance, un nuevo serotipo de salmonela ha irrumpido en Chile, denominado enteritidis, que ha logrado aprovechar el nuevo escenario logrado con la industrialización avícola donde miles de aves ahora conviven en pequeños espacios facilitando la infección cruzada entre ellas. La contaminación intermitente de huevos por vía transovárica o superficial permite la llegada de este agente en forma errática pero persistente al ser humano. Este nuevo escenario y la ausencia de un tratamiento antimicrobiano eficaz para este agente, obligan a que nuestro país adopte nuevas estrategias de prevención que involucran a productores, distribuidores y consumidores de productos avícolas

Cambios epidemiológicos de las salmonelosis en Chile: desde salmonella typhi a salmonella enteritidis / Changes in epidemiological patterns of salmonellosis in Chile: since salmonella typhi to salmonella enteritidis

Chile ha experimentado un cambio epidemiológico en la última década con la desaparición progresiva de la fiebre tifoidea causada mayoritariamente por Salmonella typhi y la emergencia epidémica de Salmonella enteritidis, un agente de diarrea sin tratamiento específico eficaz y ligado estrechamente a productos avícolas contaminados e inadecuadamente preparados. La fiebre tifoidea ha disminuido su importancia debido al desarrollo humano experimentado en Chile que ha significado un alto grado de cobertura de agua potable y de manejo de excretas, en conjunto con un mayor nivel de educación, factores que limitan la contaminación del ambiente por este agente y la adquisición de él por huéspedes susceptibles. A pesar de este notable avance, un nuevo serotipo de salmonela ha irrumpido en Chile, denominado enteritidis, que ha logrado aprovechar el nuevo escenario logrado con la industrialización avícola donde miles de aves ahora conviven en pequeños espacios facilitando la infección cruzada entre ellas. La contaminación intermitente de huevos por vía transovárica o superficial permite la llegada de este agente en forma errática pero persistente al ser humano. Este nuevo escenario y la ausencia de un tratamiento antimicrobiano eficaz para este agente, obligan a que nuestro país adopte nuevas estrategias de prevención que involucran a productores, distribuidores y consumidores de productos avícolas (AU)

Detección de salmonella enteritidis en muestras de productos avícolas de consumo humano en la Región Metropolitana / Detection of salmonella enteritidis in samples of poultry products for human consumption in the chilean metropolitan area

Background: Salmonella enteritidis (SE) is a frequent cause of diarrhea, and is transmitted mainly by SE contaminated eggs or poultry meat. The frequency of SE contaminated eggs or chicken meat and the risk for acquiring this pathogen is unknown in Chile. Aim: To measure SE contamination in eggs poultry meat and entrails offered in retail markets in the Metropolitan Area during two consecutive years (1998-1999). Material and methods: Samples were placed in sterile bags and transported to the laboratory before 4 hours at 4­C. Microbiologic detection was done using a standard procedure and an immunodetection assay. Results: SE was found in one of 1081 egg samples (0.09 percent). The contaminated sample was offered in a supermarket under their own commercial name. Six percent of 1154 poultry meat samples were contaminated by SE and 2.3 percent by other Salmonella serotypes. Entrails had even higher rates with 10.2 percent of 370 samples harboring SE and 2,7 percent other serotypes. Total Salmonella sp. isolates and SE isolates declined during 1999. Nine SE phagotypes were identified, predominating types 4 and 7. Conclusions: Eggs and other avian products are contaminated by different SE phagotypes and other Salmonella serotypes, implicating a risk for the consumers

Técnicas diagnósticas de infección humana por hantavirus / Diagnostic techniques for hantavirus human infection

Los hantavirus son virus envueltos, de genoma ARN trisegmentado. Los hantavirus americanos provienen de la subfamilia de roedores Sigmodontinae y pueden causar el síndrome cardiopulmonar por hantavirus (SCPH) mientras que los hantavirus europeos y asiáticos provienen de las subfamilias Murinae y Arvicolinae que pueden producir la fiebre hemorrágica con síndrome renal. En este artículo se describen las técnicas de laboratorio desarrolladas al momento actual para certificar la infección por hantavirus en humanos

Infección por hantavirus en humanos: experiencia del laboratorio de referencia para enfermedades infecciosas emergentes / Hantavirus human infection: experience of the emerging infectious diseases reference laboratory

En Chile la infección humana por hantavirus está ligada al ratón Oligoryzomys longicaudatus, reportándose la circulación de hantavirus en especímenes capturados desde la Región Metropolitana hasta la XI Región. Se han notificado casos de síndrome cardiopulmonar por hantavirus desde la sexta a la undécima regiones. La emergencia de esta enfermedad en la población chilena estimuló el desarrollo de un laboratorio nacional de referencia para su diagnóstico etiológico. Se describen las etapas de desarrollo de este laboratorio y su contribución a establecer el trazado epidemiológico de la infección en Chile. Relatamos brevemente el aislamiento postmortem de virus Andes a partir de un niño

Síndrome de schock tóxico por streptococcus B-hemolítico grupo A: estudio de la relación clonal entre un caso y sus contactos / Toxic shock syndrome: clonal relatedness among group A streptococcus isolates from a case and its contacts

Group A Streptococcal infections have increased in severity and frequency worldwide. We report a female patient that was admitted by Group A Streptococal lethal toxic shock syndrome due to pharyngitis as the primary focus and without cutaneous involvement. Streptococcus pyogenes was isolated from blood cultures and case definition fulfilled standard recommendations. Epidemiological studies among family members showed that two children (aged 5 and 12 years) harbored the same strain in their pharynxes as confirmed by arbitrarily primed PCR (AP-PCR) using primers ERIC and Pn-1. Control strains were included in the analysis. None of three health care workers involved in intubation and laryngoscopic procedures with the patient carried S pyogenes. AP-PCR appears to be a useful and rapid procedure to demonstrate clonal relatedness among S pyogenes strains